Accelerated multi-snapshot free-breathing B1+ mapping based on the dual refocusing echo acquisition mode technique (DREAM): An alternative to measure RF nonuniformity for cardiac MRI.

BACKGROUND: Field inhomogeneities in MRI caused by interactions between the radiofrequency field and the patient anatomy can lead to artifacts and contrast variations, consequently degrading the overall image quality and thereby compromising diagnostic value of the images. PURPOSE: To develop an efficient free-breathing and motion-robust B1+ mapping method that allows for the investigation of spatial homogeneity of the transmitted radiofrequency field in the myocardium at 3.0T. Three joint approaches are used to adapt the dual refocusing echo acquisition mode (DREAM) sequence for cardiac applications: (1) electrocardiograph triggering; (2) a multi-snapshot undersampling scheme, which relies on the Golden Ratio, to accelerate the acquisition; and (3) motion-compensation based on low-resolution images acquired in each snapshot. STUDY TYPE: Prospective. PHANTOM/SUBJECTS: Eurospin II T05 system, torso phantom, and five healthy volunteers. FIELD STRENGTH/SEQUENCE: 3.0T/DREAM. ASSESSMENT: The proposed method was compared with the Bloch-Siegert shift (BSS) method and validated against the standard DREAM sequence. Cardiac B1+ maps were obtained in free-breathing and breath-hold as a proof of concept of the in vivo performance of the proposed method. STATISTICAL TESTS: Mean and standard deviation (SD) values were analyzed for six standard regions of interest within the myocardium. Repeatability was assessed in terms of SD and coefficient of variation. RESULTS: Phantom results indicated low deviation from the BSS method (mean difference = 3%). Equivalent B1+ distributions for free-breathing and breath-hold in vivo experiments demonstrated the motion robustness of this method with good repeatability (SD < 0.05). The amount of B1+ variations was found to be 26% over the myocardium within a short axis slice. DATA CONCLUSION: The feasibility of a cardiac B1+ mapping method with high spatial resolution in a reduced scan time per trigger was demonstrated. The free-breathing characteristic could be beneficial to determine shim components for multi-channel systems, currently limited to two for a single breath-hold. LEVEL OF EVIDENCE: 1 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;49:499-507.

Specialized functions of the PP2A subfamily II catalytic subunits PP2A-C3 and PP2A-C4 in the distribution of auxin fluxes and development in Arabidopsis.

Protein phosphorylation is a key molecular switch used to transmit information in biological signalling networks. The output of these signalling circuits is governed by the counteracting activities of protein kinases and phosphatases that determine the direction of the switch. Whereas many kinases have been functionally characterized, it has been difficult to ascribe precise cellular roles to plant phosphatases, which are encoded by enlarged gene families that may provide a high degree of genetic redundancy. In this work we have analysed the role in planta of catalytic subunits of protein phosphatase 2A (PP2A), a family encoded by five genes in Arabidopsis. Our results indicate that the two members of subfamily II, PP2A-C3 and PP2A-C4, have redundant functions in controlling embryo patterning and root development, processes that depend on auxin fluxes. Moreover, polarity of the auxin efflux carrier PIN1 and auxin distribution, determined with the DR5(pro) :GFP proxy, are affected by mutations in PP2A-C3 and PP2A-C4. Previous characterization of mutants in putative PP2A regulatory subunits had established a link between this class of phosphatases and PIN dephosphorylation and subcellular distribution. Building on those findings, the results presented here suggest that PP2A-C3 and PP2A-C4 catalyse this reaction and contribute critically to the establishment of auxin gradients for proper plant development.

Digestive toxicity in cancer treatments. Bibliographic review. Influence on nutritional status.

INTRODUCTION: The cause of death can be attributed to malnutrition in 10-20% of cancer patients. Patients with sarcopenia present more chemotherapy toxicity, less progression-free time, less functional capacity and more surgical complications. Antineoplastic treatments have a high prevalence of adverse effects that compromise nutritional status. The new chemotherapy agents present direct toxicity on the digestive tract (nausea, vomiting, diarrhoea and/or mucositis). We present the frequency of adverse effects with nutritional impact of the most frequent chemotherapy agents used in the treatment of solid tumours, as well as strategies for early diagnosis and nutritional treatment. MATERIAL AND METHODS: Review of commonly used cancer treatments (cytotoxic agents, immunotherapy, targeted therapies) in colorectal, liver, pancreatic; lung, melanoma, bladder, ovary, prostate and kidney cancer. The frequency (%) of gastrointestinal effects, and those of grade ≥3 are recorded. A systematic bibliographic search was carried out in PubMed, Embase, UpToDate, international guides and technical data sheets. RESULTS: They are shown in the form of tables in which the drugs appear together with the probability that they present any digestive adverse effect and the percentage of serious adverse effects (Grade ≥ 3). DISCUSSION: Antineoplastic drugs are associated with a high frequency of digestive complications with nutritional repercussions, which can reduce QoL and cause death as a result of malnutrition or due to the limiting effect of suboptimal treatments, closing the malnutrition-toxicity loop. It is necessary to inform the patient about the risks and establish local protocols regarding the use of antidiarrheal drugs, antiemetics and adjuvants in the management of mucositis. We propose action algorithms and dietary advice that can be used directly in clinical practice, to prevent the negative consequences of malnutrition.

How much do we care about teacher job insecurity during the pandemic? A bibliometric review.

In this study, a descriptive bibliometric analysis of the scientific production in the Web of Science on job insecurity perceived by teachers in pandemic situations was carried out. The result shows the growing interest in the topic with an upward trend with an annual growth of 41.52%. Forty-seven papers from 41 journals with 2,182 cited references were considered, with 149 researchers from 30 countries publishing at least one article. The country with the most publications was the United States, followed by Germany and Spain. The United States was the country with the most collaborations. A total of 95 institutions published papers, and the universities with the most registrations were Miami University and the University of the Basque Country, although York University and the University of the Basque Country had a higher overall citation coefficient (102 and 40, respectively). Of the 41 journals that have published on the topic, Frontiers in Education and the British Journal of Educational Psychology stood out in terms of their article numbers. However, this last one was superior in terms of the overall number of citations per year, followed by Frontiers of Psychology.

Expansion of Paneth cell population in response to enteric Salmonella enterica serovar Typhimurium infection.

Paneth cells residing at the base of the small intestinal crypts contribute to the mucosal intestinal first line defense by secreting granules filled with antimicrobial polypeptides including lysozyme. These cells derive from the columnar intestinal stem cell located at position 0 and the transit amplifying cell located at position +4 in the crypts. We have previously shown that Salmonella enterica serovar Typhimurium (ST), a leading cause of gastrointestinal infections in humans, effects an overall reduction of lysozyme in the small intestine. To extend this work, we examined small-intestinal tissue sections at various time points after ST infection to quantify and localize expression of lysozyme and assess Paneth cell abundance, apoptosis, and the expression of Paneth cell differentiation markers. In response to infection with ST, the intestinal Paneth cell-specific lysozyme content, the number of lysozyme-positive Paneth cells, and the number of granules per Paneth cell decreased. However, this was accompanied by increases in the total number of Paneth cells and the frequency of mitotic events in crypts, by increased staining for the proliferation marker PCNA, primarily at the crypt side walls where the transit amplifying cell resides and not at the crypt base, and by apoptotic events in villi. Furthermore, we found a time-dependent upregulation of first ß-catenin, followed by EphB3, and lastly Sox9 in response to ST, which was not observed after infection with a Salmonella pathogenicity island 1 mutant deficient in type III secretion. Our data strongly suggest that, in response to ST infection, a Paneth cell differentiation program is initiated that leads to an expansion of the Paneth cell population and that the transit amplifying cell is likely the main progenitor responder. Infection-induced expansion of the Paneth cell population may represent an acute intestinal inflammatory response similar to neutrophilia in systemic infection.

How Much Do We Care about Teacher Burnout during the Pandemic: A Bibliometric Review.

In this study, a descriptive bibliometric analysis of the scientific production was performed in the Web of Science on burnout and/or stress in teachers in pandemic situations. The aim of the study was to analyse the scientific production on stress and burnout in teachers during the COVID-19 pandemic. A total of 75 documents from 33 journals with 3947 cited references were considered, with 307 researchers from 35 countries publishing at least one article. The country with the most publications was the USA, followed by China and Spain. The USA was the country with the most collaborations. A total of 184 institutions published documents, and the universities with the most records were Christopher Newport and Columbia, although the American University of Sharjah and Cape Breton University had a higher overall citation coefficient. Of the 33 journals that have published on the subject, Frontiers in Psychology and the International Journal of Environmental Research and Public Health stood out in terms of the number of articles, and they were also listed in this order with regard to their impact factor.

Superparamagnetic-blocked state transition under alternating magnetic fields: towards determining the magnetic anisotropy in magnetic suspensions.

The potential of magnetic nanoparticles for acting as efficient catalysts, imaging tracers or heating mediators relays on their superparamagnetic behaviour under alternating magnetic fields. In spite of the relevance of this magnetic phenomenon, the identification of specific fingerprints to unequivocally assign superparamagnetic behaviour to nanomaterials is still lacking. Herein, we report on novel experimental and theoretical evidences related to the superparamagnetism observed in magnetic iron oxide nanoparticle suspensions at room temperature. AC magnetization measurements in a broad field frequency range from mHz to kHz and field intensities up to 40 kA m-1 unambiguously demonstrate the transition from superparamagnetic to blocked states at room temperature. Our experimental observations are supported by a theoretical model based on the stochastic Landau-Liftshitz-Gilbert equation. An empirical expression is proposed to determine the effective magnetic anisotropy from the field frequency value beyond which AC magnetization shows hysteretic behaviour. Our results significantly improve the understanding and description of the superparamagnetism of iron oxide nanoparticles, paving the way towards a more efficient exploitation of their unique magnetic properties.

Increasing omega-3 desaturase expression in tomato results in altered aroma profile and enhanced resistance to cold stress.

One of the drawbacks in improving the aroma properties of tomato (Solanum lycopersicum) fruit is the complexity of this organoleptic trait, with a great variety of volatiles contributing to determine specific quality features. It is well established that the oxylipins hexanal and (Z)-hex-3-enal, synthesized through the lipoxygenase pathway, are among the most important aroma compounds and impart in a correct proportion some of the unique fresh notes in tomato. Here, we confirm that all enzymes responsible for the synthesis of these C6 compounds are present and active in tomato fruit. Moreover, due to the low odor threshold of (Z)-hex-3-enal, small changes in the concentration of this compound could modify the properties of the tomato fruit aroma. To address this possibility, we have overexpressed the omega-3 fatty acid desaturases FAD3 and FAD7 that catalyze the conversion of linoleic acid (18:2) to linolenic acid (18:3), the precursor of hexenals and its derived alcohols. Transgenic OE-FAD tomato plants exhibit altered fatty acid composition, with an increase in the 18:3/18:2 ratio in leaves and fruits. These changes provoke a clear variation in the C6 content that results in a significant alteration of the (Z)-hex-3-enal/hexanal ratio that is particularly important in ripe OE-FAD3FAD7 fruits. In addition to this effect on tomato volatile profile, OE-FAD tomato plants are more tolerant to chilling. However, the different behaviors of OE-FAD plants underscore the existence of separate fatty acid fluxes to ensure plant survival under adverse conditions.

Dialogic Learning Environments That Enhance Instrumental Learning and Inclusion of Students With Special Needs in Secondary Education.

Across Europe, the enrolment of students with special educational needs in regular classrooms is increasing, although it does not always mean access to high quality educational experience. In this context, inclusive education has been enhanced in most educational systems, but its successful implementation is still limited and has become a challenge in most countries, and specially in secondary education, when segregation due to learning achievement is more frequent. Educational practices that take into account the potential of promoting learning interactions within heterogeneous groups of students have already demonstrated contributing to educational inclusion of students with special needs. In this study we analyse the case of a secondary education school located in Valencian Community (Spain), which educates students with special needs along with their typically developing peers and is characterized by its inclusive ethos. The analysis focuses on three educational strategies implemented in the school and their impact on educational improvement and inclusion of the students with special needs: (1) co-teaching, (2) interactive groups, (3) dialogic literary gatherings. Qualitative data were obtained from communicative focus groups with teachers, communicative life stories with students and relatives, communicative observations of the three educational strategies and documentary analysis. The findings show significant increase in the students' instrumental learning, as well as an improvement in these students' overall inclusion in the school.

The Community Health Worker (CHW) Common Indicators Project: Engaging CHWs in Measurement to Sustain the Profession.

Despite progress in documenting the outcomes of Community Health Worker interventions, the lack of standardized measures to assess CHW practice has made it difficult for programs to conduct reliable evaluations, and impossible to aggregate data across programs and regions, impeding commitment to sustainable, long-term financing of CHW programs. In addition, while CHWs have sometimes been involved as data collectors, they have seldom been engaged as full partners in all stages of evaluation and research. This manuscript details the current work being done by the CI Project, demonstrating how CHWs are able to contribute to the integrity, sustainability, and viability of CHW programs through the collaborative development and adoption of a set of common process and outcome constructs and indicators for CHW practice and CHW program implementation.

Síndromes de la salida torácica y tratamiento quirúrgico

Introducción: Los síndromes de compresión de la salida torácica, en ocasiones poco definidos, se caracterizan por cervicobraquialgia como principal síntoma. Se deben a una compresión del tronco inferior del plexo braquial o de los vasos subclavios, estructuras que atraviesan la salida torácica. No ha sido establecida ninguna técnica diagnóstica y su tratamiento incluye la fisioterapia, medicamentos como los analgésicos y, en algunos casos, la cirugía. Objetivo: Presentar los resultados obtenidos con el tratamiento quirúrgico a pacientes que fueron diagnosticados, según su etiología, con diferentes síndromes de la salida torácica. Métodos: Se realizó un estudio a 131 pacientes diagnosticados como síndromes de la salida torácica, atendidos con síntomas referentes a estos en un periodo de 12 años, y que fueron intervenidos quirúrgicamente. El diagnóstico causal se basó en la clínica, estudios radiológicos, ultrasonográficos y electromiográficos y valoración de los factores de riesgo. Resultados: La edad más frecuente fue la tercera década de la vida y el sexo femenino fue más afectado. Como agente causal, las costillas cervicales supernumerarias y las apófisis costiformes se presentaron en mayor porcentaje, contituyendo la escalenotomia anterior y media el proceder quirúrgico más efectuado. Conclusiones: Los síntomas neurológicos evidenciaron una compresión nerviosa en la mayoría de los casos, y los resultados evaluados como buenos los más frecuentes, demostrando que el tratamiento quirúrgico de esta patología forma parte esencial de las mismas.

Introduction: Thoracic outlet compression syndromes, sometimes poorly defined, are characterized by cervicobrachialgia as the main symptom. They are due to compression of the lower trunk of the brachial plexus or the subclavian vessels, structures that cross the thoracic outlet. No diagnostic technique has been established and its treatment includes physiotherapy, medications such as analgesics and, in some cases, surgery. Objective: To present the results obtained with the surgical treatment of patients who were diagnosed, according to their etiology, with different thoracic outlet syndromes. Methods: A study was carried out on 131 patients diagnosed as thoracic outlet syndromes, treated with symptoms related to these in a period of 12 years, and who underwent surgery. The causal diagnosis was based on the symptoms, radiological, ultrasonographic and electromyographic studies and assessment of risk factors. Results: The most frequent age was the third decade of life and the female sex was more affected. As a causal agent, the supernumerary cervical ribs and the costiform processes were present in a higher percentage, constituting the anterior and median scalenotomy the most performed surgical procedure. Conclusions: The neurological symptoms evidenced nerve compression in most cases, and the results evaluated as good in the most frequent, demonstrating that the surgical treatment of this pathology is an essential part of them.

Polyostotic fibrous dysplasia associated with intramuscular myxomas: Mazabraud syndrome.

The authors report a new case of Mazabraud syndrome in a 69-year-old woman complaining of pain in her right thigh. Plain radiographs demonstrated radiological findings consistent with polyostotic fibrous dysplasia of the right femur and tibia. Magnetic resonance imaging (MRI) study showed soft tissue tumors located in the vastus intermedius muscle with typical signal features of intramuscular myxomas. Biopsy was not performed because of its benign nature. Symptomatic treatment was prescribed and all the lesions remained 1 year after the diagnosis.

Determinants of vaccine immunogenicity in HIV-infected pregnant women: analysis of B and T cell responses to pandemic H1N1 monovalent vaccine.

Influenza infections have high frequency and morbidity in HIV-infected pregnant women, underscoring the importance of vaccine-conferred protection. To identify the factors that determine vaccine immunogenicity in this group, we characterized the relationship of B- and T-cell responses to pandemic H1N1 (pH1N1) vaccine with HIV-associated immunologic and virologic characteristics. pH1N1 and seasonal-H1N1 (sH1N1) antibodies were measured in 119 HIV-infected pregnant women after two double-strength pH1N1 vaccine doses. pH1N1-IgG and IgA B-cell FluoroSpot, pH1N1- and sH1N1-interferon γ (IFNγ) and granzyme B (GrB) T-cell FluoroSpot, and flow cytometric characterization of B- and T-cell subsets were performed in 57 subjects. pH1N1-antibodies increased after vaccination, but less than previously described in healthy adults. pH1N1-IgG memory B cells (Bmem) increased, IFNγ-effector T-cells (Teff) decreased, and IgA Bmem and GrB Teff did not change. pH1N1-antibodies and Teff were significantly correlated with each other and with sH1N1-HAI and Teff, respectively, before and after vaccination. pH1N1-antibody responses to the vaccine significantly increased with high proportions of CD4+, low CD8+ and low CD8+HLADR+CD38+ activated (Tact) cells. pH1N1-IgG Bmem responses increased with high proportions of CD19+CD27+CD21- activated B cells (Bact), high CD8+CD39+ regulatory T cells (Treg), and low CD19+CD27-CD21- exhausted B cells (Bexhaust). IFNγ-Teff responses increased with low HIV plasma RNA, CD8+HLADR+CD38+ Tact, CD4+FoxP3+ Treg and CD19+IL10+ Breg. In conclusion, pre-existing antibody and Teff responses to sH1N1 were associated with increased responses to pH1N1 vaccination in HIV-infected pregnant women suggesting an important role for heterosubtypic immunologic memory. High CD4+% T cells were associated with increased, whereas high HIV replication, Tact and Bexhaust were associated with decreased vaccine immunogenicity. High Treg increased antibody responses but decreased Teff responses to the vaccine. The proportions of immature and transitional B cells did not affect the responses to vaccine. Increased Bact were associated with high Bmem responses to the vaccine.

Heterogeneity of T Cell Responses to Pandemic pH1N1 Monovalent Vaccine in HIV-Infected Pregnant Women.

We investigated the Th1 protective and regulatory T and B cell (Treg and Breg) responses to pH1N1 monovalent influenza vaccine (IIV1) in HIV-infected pregnant women on combination antiretroviral therapy (cART). Peripheral blood mononuclear cells (PBMCs) from 52 study participants were cryopreserved before and after vaccination and analyzed by flow cytometry. pH1N1-specific Th1, Treg, and Breg responses were measured in PBMCs after in vitro stimulation with pH1N1 and control antigen. The cohort analysis did not detect changes in pH1N1-Th1, Treg, or Breg subsets postvaccination. However, individual analyses distinguished subjects who mounted vigorous Th1 responses postvaccination from others who did not. Postvaccination, high pH1N1-Th1 correlated with high pH1N1-Treg and Breg responses, suggesting that low influenza effector responses did not result from excessive vaccine-induced immune regulation. High postvaccination pH1N1-Th1 responses correlated with baseline high PHA- and pH1N1-IFN-γ ELISpot and circulating CD4(+)CD39(+)% and CD8(+)CD39(+)% Treg, with low CD8(+) cell numbers and CD19(+)FOXP3(+)% Breg, but not with CD4(+) cell numbers or HIV viral load. These data highlight the heterogeneity of T cell responses to vaccines in HIV-infected individuals on cART. Predictors of robust Th1 responses to IIV include CD8(+) cell numbers, T cell functionality, and circulating Breg and Treg.

Characterization of functional antibody and memory B-cell responses to pH1N1 monovalent vaccine in HIV-infected children and youth.

OBJECTIVES: We investigated immune determinants of antibody responses and B-cell memory to pH1N1 vaccine in HIV-infected children. METHODS: Ninety subjects 4 to <25 years of age received two double doses of pH1N1 vaccine. Serum and cells were frozen at baseline, after each vaccination, and at 28 weeks post-immunization. Hemagglutination inhibition (HAI) titers, avidity indices (AI), B-cell subsets, and pH1N1 IgG and IgA antigen secreting cells (ASC) were measured at baseline and after each vaccination. Neutralizing antibodies and pH1N1-specific Th1, Th2 and Tfh cytokines were measured at baseline and post-dose 1. RESULTS: At entry, 26 (29%) subjects had pH1N1 protective HAI titers (≥1:40). pH1N1-specific HAI, neutralizing titers, AI, IgG ASC, IL-2 and IL-4 increased in response to vaccination (p<0.05), but IgA ASC, IL-5, IL-13, IL-21, IFNγ and B-cell subsets did not change. Subjects with baseline HAI ≥1:40 had significantly greater increases in IgG ASC and AI after immunization compared with those with HAI <1:40. Neutralizing titers and AI after vaccination increased with older age. High pH1N1 HAI responses were associated with increased IgG ASC, IFNγ, IL-2, microneutralizion titers, and AI. Microneutralization titers after vaccination increased with high IgG ASC and IL-2 responses. IgG ASC also increased with high IFNγ responses. CD4% and viral load did not predict the immune responses post-vaccination, but the B-cell distribution did. Notably, vaccine immunogenicity increased with high CD19+CD21+CD27+% resting memory, high CD19+CD10+CD27+% immature activated, low CD19+CD21-CD27-CD20-% tissue-like, low CD19+CD21-CD27-CD20-% transitional and low CD19+CD38+HLADR+% activated B-cell subsets. CONCLUSIONS: HIV-infected children on HAART mount a broad B-cell memory response to pH1N1 vaccine, which was higher for subjects with baseline HAI≥1:40 and increased with age, presumably due to prior exposure to pH1N1 or to other influenza vaccination/infection. The response to the vaccine was dependent on B-cell subset distribution, but not on CD4 counts or viral load. TRIAL REGISTRATION: ClinicalTrials.gov NCT00992836.

High proportions of regulatory B and T cells are associated with decreased cellular responses to pH1N1 influenza vaccine in HIV-infected children and youth (IMPAACT P1088).

HIV-infected individuals have poor responses to inactivated influenza vaccines. To evaluate the potential role of regulatory T (Treg) and B cells (Breg), we analyzed their correlation with humoral and cell-mediated immune (CMI) responses to pandemic influenza (pH1N1) monovalent vaccine in HIV-infected children and youth. Seventy-four HIV-infected, 4- to 25-y old participants in a 2-dose pH1N1 vaccine study had circulating and pH1N1-stimulated Treg and Breg measured by flow cytometry at baseline, post-dose 1 and post-dose 2. Concomitantly, CMI was measured by ELISPOT and flow cytometry; and antibodies by hemagglutination inhibition (HAI). At baseline, most of the participants had pH1N1-specific IFNγ ELISPOT responses, whose magnitude positively correlated with the baseline pH1N1, but not with seasonal H1N1 HAI titers. pH1N1-specific IFNγ ELISPOT responses did not change post-dose 1 and significantly decreased post-dose 2. In contrast, circulating CD4+CD25+% and CD4+FOXP3+% Treg increased after vaccination. The decrease in IFNγ ELISPOT results was marginally associated with higher pH1N1-specific CD19+FOXP3+ and CD4+TGFß+% Breg and Treg, respectively. In contrast, increases in HAI titers post-dose 1 were associated with significantly higher circulating CD19+CD25+% post-dose 1, whereas increases in IFNγ ELISPOT results post-dose 1 were associated with higher circulating CD4+/C8+CD25+FOXP3+%. In conclusion, in HIV-infected children and youth, influenza-specific Treg and Breg may contribute to poor responses to vaccination. However, robust humoral and CMI responses to vaccination may result in increased circulating Treg and/or Breg, establishing a feed-back mechanism.

Depletion of serum carotenoid and other fat-soluble vitamin concentrations following obesity surgery.

BACKGROUND: Obesity constitutes a growing health problem, and surgical treatment of severe obesity is increasingly used. Nutrient deficiencies are common following bariatric surgery and the evidence indicates a progressive increase in the incidence and severity of the deficiency of certain vitamins and related clinical conditions. Because of the potential role of carotenoids in disease prevention, our aim was to assess the carotenoid status in candidates for obesity surgery and the time-course changes following two bariatric procedures. METHODS: Seventy-five candidates for bariatric surgery (17 men, 58 women; age 43 ± 10 years) and a total of 362 serum samples after obesity surgery (i.e., Roux-en-Y gastric bypass (n = 187) and biliopancreatic diversion (n = 175)) were consecutively collected and assessed. Retinol, α- and γ-tocopherol, 25-OH-vitamin D3, lutein, zeaxanthin, α- and ß-cryptoxanthin, lycopene (trans and cis), α- and ß-carotene (trans and cis) were analyzed by high-performance liquid chromatography. RESULTS: Mean serum levels of carotenoids in candidates for obesity surgery were within the reference values reported in controls and seasonal variations were present in several analytes. After surgery, and regardless of the type of intervention, all serum carotenoids dropped following first-order kinetics. Cis/trans ratio of lycopene and ß-carotene did not change after surgery, over the time or between surgical procedures. On a long-term, serum carotenoids were at or below fifth percentile of reference groups. CONCLUSIONS: The chronic low levels of carotenoids in these patients compromise their availability to tissues, constituting an additional risk factor for other clinical conditions. Dietary advice on carotenoid-rich, fortified foods or supplements should be also evaluated in these patients.

Tendencias y manifestaciones del proceso de formación humanista en la Universidad de Ciencias Médicas de Pinar del Río / Trends and manifestations of the process of a humanistic instruction in Medical Science University, Pinar del Rio

Introducción: el proceso de formación humanista constituye una herramienta vital para los retos de alcanzar un alto nivel en los aspectos más trascendentes de la personalidad del estudiante y el logro de una política educacional dirigida a la preparación integral de los ciudadanos para su desempeño en la sociedad. Objetivo: identificar las principales manifestaciones de las regularidades del proceso de formación humanista en la carrera de medicina en la Universidad de Ciencias Médicas de Pinar del Río. Material y método: se desarrolló un estudio sustentado en el método dialéctico materialista por su capacidad de integrar lo cualitativo y lo cuantitativo y de determinar el sistema de métodos, por lo que se emplearon métodos teóricos, empíricos y estadísticos, dentro de los primeros, el histórico-lógico, sistémico-estructural y la revisión documental y en el segundo grupo encuestas, entrevistas y la observación. Resultados: se manifiesta la ausencia de correspondencia e interrelación con el modo de actuación profesional y social. No se contemplan los contenidos de la formación humanista, desde su transversalidad, como invariantes de conocimientos en las disciplinas y/o asignaturas. Insuficientes integración de conocimientos y habilidades y valores para la interpretación del contexto social y su preparación para transformar el contexto de salud. Conclusiones: en la Universidad de Ciencias Médicas de Pinar del Río, el proceso de formación humanista de la Carrera de Medicina manifiesta insuficiencias en su implementación, es asistémico, descontextualizado y carente de acciones secuenciadas que tributen a la interpretación del contexto socio-humanista y ético en el que se desarrolla la práctica profesional.

Introduction: the process of a humanistic instruction constitutes an essential tool to the achievement of high levels in the most important aspects of the student's personality and to accomplish an educational policy; which target is the comprehensive development of the individuals to their interaction in society. Objective: to identify the main manifestations of the regularities of a humanistic instruction process in medical studies at the Medical Science University in Pinar del Rio province. Material and method: a study supported on the dialectic-materialistic method because of its capacity of integrating qualitative and quantitative methods and even to determine a system of methods, thus theoretical, empiric and statistics methods were used as the first ones; historical-logical, systemic-structural and documentary revision. In the second group interviews, surveys and observation methods were followed. Results: no correspondence and interrelation between professional and social acting modes was found. The contents of a humanistic instruction were not observed from its transversal points of view as invariants of knowledge in the disciplines and/or subjects. Skills and value judgements to interpret the social context and their preparation to transform the health context showed not sufficient integration of knowledge. Conclusions: at the Medical Science University in Pinar del Rio, the process of a humanistic instruction in Medical Studies shows insufficiencies in its implementation, it is not systemic; it is not contextualized and not a sequential follow up of actions responding to the interpretation of a socio-humanistic and ethical context to develop the professional practice was observed as well.

Regularidades del proceso formativo en Medicina Tradicional y Natural. Carrera de Medicina. Pinar del Río / Regularities of the training process in Natural and Traditional Medicine. Medical Studies, Pinar del Rio

Introducción: el proceso formativo en Medicina Tradicional y Natural en la carrera de Medicina se formalizó en el curso 2010-2011. Objetivo: Mostrar las regularidades del proceso formativo en Medicina Tradicional y Natural en la carrera de Medicina, Universidad de Ciencias Médicas de Pinar del Río, cursos 2008/2009 y 2011/2012. Material y método: estudio descriptivo longitudinal prospectivo. Universo: Estudiantes: 5to año de Medicina, (2008/2009 -206- y 2011/2012 -199), profesores 82 y metodólogos 10. Muestra: Criterio intencional. 2008/2009, 108 estudiantes (52,43 %) y 2011/2012 98 estudiantes (49.25 %). Profesores principales 68 (82,92 %) y metodólogos 4, (40 %). Métodos empíricos: observación, encuesta, análisis documental, estadística descriptiva. Resultados: en 2008 el 93,51 % de los estudiantes refirió que adquirió conocimientos de Medicina Tradicional y Natural, superior al 2011. La vía más común de adquisición de conocimientos en ambos cursos fueron las asignaturas del ciclo clínico, 76.85 % en 2008/2009 y 78.26 % 2011/2012. La vía extracurricular que más aportó fue el tiempo electivo, 45,37 % en 2008/2009, superior 2011/2012. La modalidad más conocida por los estudiantes en 2008/2009 fue la fitoterapia (74,07 %) y en 2011/2012 la acupuntura (69.56 %). En 2011/2012 solo 6.52 % de los estudiantes adquirieron habilidades necesarias. 88.23% de los profesores consideraron que la preparación en Medicina Tradicional y Natural debe alcanzarse en el pregrado. Conclusiones: el proceso formativo en Medicina Tradicional y Natural en la carrera de Medicina es adecuadamente valorado por profesores y estudiantes, pero fragmentado, asistémico y no logra habilidades suficientes en los estudiantes.

Introduction: the training process in Natural and Traditional Medicine. Medical Studies, Pinar del Rio was officially established in the academic course 2010-2011. Objective: to show the regularities of the training process in Natural and Traditional Medicine at the Medical Sciences University in Pinar del Rio during the academic courses 2008/2009 and 2011/2012. Material and method: descriptive, longitudinal and prospective study. The target group comprised of medical students (2008/2009 -206- y 2011/2012 -199) from 5th academic year, professors (82) and methodologists (10). Sample: intentional criterion 2008/2009, 108 students (52,43%) and 2011/2012- 98 students (49,25%). Main professors 68 (82,92%), methodologists 4 (40%). Empirical methods: observation, survey, documentary analysis, descriptive statistics were used. Results: in 2008 the students (93,51%) referred they acquired knowledge of Natural and Traditional Medicine, higher than 2011. The most common way of acquiring knowledge in both courses were the subjects of the clinical cycle, 76,85% in 2008/2009 and 78.26% in 2011/2012. The extracurricular way that most contributed was the elective time (45,37%) in 2008/2009, greater than 2011/2012. Herbal medicine (74,07%) was the better known in 2008/2009 with acupuncture (69.56%). In 2011/2012 only 6.25% of the students acquired the necessary skills. Professors (88.23%) considered that the training process in the use of Natural and Traditional Medicine should be carried out in pre-graduate periods. Conclusions: the training process of Natural and Traditional Medicine in medical studies is properly appraised by professors and students, but as it is fragmented and non-systemic, skills are not sufficiently developed.

Estrategia pedagógica para el proceso formativo en medicina tradicional y natural en la carrera de medicina / A pedagogical strategy to the training process of Natural and Traditional Medicine in medical studies

Introducción: el proceso formativo en Medicina Tradicional y Natural en la carrera de Medicina se ejecuta a través de una estrategia curricular desde el curso 2010-2011. Objetivo: fundamentar una estrategia para la implementación de la concepción pedagógica del proceso formativo en Medicina Tradicional y Natural en la carrera de Medicina, en la Universidad de Ciencias Médicas de Pinar del Río, entre 2008 y 2014. Material y método: estudio cuanti-cualitativo, descriptivo, entre 2008 y 2014. Parte de un diagnóstico previo de las regularidades del proceso formativo en Medicina Tradicional y Natural en la carrera de Medicina en la Universidad de Ciencias Médicas de Pinar del Río. Métodos teóricos: análisis y síntesis, modelación y sistémico estructural. Métodos empíricos: reuniones de grupo focal, entrevistas grupales y análisis documental. Resultados: se determinaron las bases teóricas de la concepción pedagógica del proceso formativo en Medicina Tradicional y Natural en la carrera de Medicina y se estructuró una estrategia para implementar dicha concepción. Se identificaron 7 fortalezas, 6 debilidades, 5 oportunidades y 5 amenazas. Partiendo del objetivo, las acciones tributan al perfeccionamiento curricular , a la preparación en Medicina Tradicional y Natural del claustro de la carrera de Medicina y la creación de un clima pedagógico institucional. Se expuso el resultado de la aplicación de 2 acciones específicas. Conclusiones: se estructuró una estrategia pedagógica para el proceso formativo en Medicina Tradicional y Natural en la carrera de Medicina. El carácter participativo de la acción estratégica realizada y el enfoque pedagógico en el diseño y ejecución de los programas de capacitación, generó un clima favorable para la implementación de la estrategia.

Introduction: the training process of Natural and Traditional Medicine in medical studies is conducted by means of a curricular strategy implemented from the academic course 2010-2011. Objective: to support a strategy to the implementation of a pedagogical conception of the training process in Natural and Traditional Medicine in medical studies at the University of Medical Sciences in Pinar del Rio all along 2008-2014. Material and method: a quantitative and qualitative, descriptive study taking the period of 2008-2014, from a previous analysis of the regularities found in the training process of Natural and Traditional Medicine in medical studies at the University of Medical Sciences in Pinar del Rio. Theoretical methods: analysis and synthesis, modelling and systemic structural. Empirical methods: meetings of the focal group, interviews of groups and documentary analysis. Results: the theoretical bases of the pedagogical conception of the training process of Natural and Traditional Medicine in medical studies were determined, structuring a strategy to implement this conception, where the strengths (7), weakness (6), opportunities (5) and threats (5) were determined. Concerning the objective, the actions responded to the curricular development, to the training of the teaching staff in Natural and Traditional Medicine in medical studies, plus to the creation of pedagogical-institutional environment. The results of the application of two specific actions were illustrated. Conclusions: a pedagogical strategy was structured to the training process of Natural and Traditional Medicine in medical studies. The participatory feature of the pedagogical action conducted along with the pedagogical approach in the design and implementation of the training program created a favourable environment to implement the strategy.